Provider Demographics
NPI:1265164602
Name:ONGWENYI, JEMIMAH NYABOE
Entity type:Individual
Prefix:MS
First Name:JEMIMAH
Middle Name:NYABOE
Last Name:ONGWENYI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BIRKDALE CT
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-4715
Mailing Address - Country:US
Mailing Address - Phone:609-694-6520
Mailing Address - Fax:
Practice Address - Street 1:5 BIRKDALE CT
Practice Address - Street 2:
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-4715
Practice Address - Country:US
Practice Address - Phone:609-694-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ013005500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily